Intensity-modulated radiation therapy (IMRT) improves disease control and reduces treatment-related toxicity in patients with localized nasopharyngeal carcinoma (NPC). However, due to the proximity of the auditory apparatus to the treatment volume and the frequent incorporation of cisplatin-based chemotherapy, treatment-related sensorineural hearing loss (SNHL) remains a common debilitating complication among NPC survivors. The reported crude incidence of SNHL following IMRT for NPC varies widely at 1–46% due to differences in auditory assessment methods and thresholds, follow-up durations, chemotherapy usage, and patient compositions. International guidelines and radiation dosimetric studies have recommended constraining the cochlear mean dose to less than 44–50 Gy, but the risk of SNHL remains high despite adherence to these constraints. Potential strategies to improve hearing outcomes in NPC survivors include cautious de-escalation of radiotherapy dose and volume, individualization of cochlear constraints, optimization of radiotherapy planning techniques, and the use of substitutes or alternative schedules for cisplatin-based chemotherapy. The addition of immune checkpoint inhibitors to chemoradiotherapy did not impact ototoxicity. Prospective studies that employ both objective and patient-reported auditory outcomes are warranted to test the long-term benefits of various approaches. This article aims to provide a comprehensive review of the incidence and radiation dose–toxicity relationship of SNHL in NPC survivors and to summarize potential strategies to optimize hearing outcomes in relation to nuances in radiotherapy planning and the selection of systemic therapy.
调强放射治疗（IMRT）可改善局部鼻咽癌（NPC）患者的疾病控制并降低治疗相关毒性。然而，由于听觉器官邻近治疗靶区，且常联合以顺铂为基础的化疗，治疗相关的感音神经性听力损失（SNHL）仍是鼻咽癌幸存者中常见的致残性并发症。由于听力评估方法与阈值、随访时长、化疗使用情况及患者构成存在差异，鼻咽癌患者接受IMRT后SNHL的粗发生率报道差异较大，介于1%至46%之间。国际指南和放射剂量学研究建议将耳蜗平均剂量限制在44–50 Gy以下，但即使遵循这些限制，SNHL的风险仍然较高。改善鼻咽癌幸存者听力结局的潜在策略包括：谨慎降低放疗剂量和靶区范围、个体化耳蜗剂量限制、优化放疗计划技术，以及使用替代药物或调整顺铂化疗方案。在放化疗基础上加用免疫检查点抑制剂未对耳毒性产生影响。有必要开展结合客观听力评估与患者报告结局的前瞻性研究，以验证各种方法的长期获益。本文旨在全面综述鼻咽癌幸存者SNHL的发生率及其与放射剂量的毒性关系，并基于放疗计划细节和全身治疗方案选择，总结优化听力结局的潜在策略。
肿瘤(癌症)患者之家